View source for Vision therapy

{{Short description|Alternative medicine treatment using eye exercises aimed at improving sight}}
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{{Alternative medicine sidebar |fringe}}
'''Vision therapy''' ('''VT'''), or '''behavioral optometry''', is an umbrella term for [[alternative medicine]] treatments using eye exercises, based around the [[pseudoscientific]] claim that vision problems are the true underlying cause of learning difficulties, particularly in children.<ref name=novella/> Vision therapy has not been shown to be effective using scientific studies, except for helping with [[convergence insufficiency]].<ref name=Barrett/> Most claims{{--}}for example that the therapy can address neurological, educational, and spatial difficulties{{--}}lack supporting evidence.<ref name=kidding/> Neither the [[American Academy of Pediatrics]] nor the American Academy of Ophthalmology support the use of vision therapy.<ref name="stlbeacon1">{{cite web|url=https://www.stlbeacon.org/#!/content/17515/vision_therapy_part_2|title=Ophthalmologists express skepticism about vision therapy|date=30 Nov 2010|publisher=St. Louis Beacon|author=Jo Seltzer|url-status=dead|archive-url=https://web.archive.org/web/20130720014459/http://stlbeacon.org/#!/content/17515/vision_therapy_part_2|archive-date=2013-07-20}}</ref><ref name="nytimes1">{{cite news | url=https://www.nytimes.com/2010/03/14/magazine/14vision-t.html|title=Concocting a Cure for Kids With Issues|date=10 March 2010|author=Judith Warner|newspaper=The New York Times}}</ref>

==Definition and conceptual basis==

Vision therapy is based on the proposition that many learning disabilities in children are based on vision problems, and that these can be cured by performing eye exercises. Vision therapy lacks sound evidence, has been characterized as a [[pseudoscience]] and its practice as [[quackery]].<ref name=pseudo>{{cite book |title=Pseudoscience in Child and Adolescent Psychotherapy: A Skeptical Field Guide |veditors=Hupp S |chapter=Chapter 5: Learning |vauthors=LaBrot Z, Dufrene B |pages=66–79 |year=2019 |publisher=Cambridge University Press |isbn=9781107175310 |doi=10.1017/9781316798096.007|s2cid=240819473 }}</ref><ref name=novella>{{cite web |title=Vision Therapy Quackery |vauthors=Novella S |publisher=[[Science-Based Medicine]] |date=31 January 2018 |url=https://sciencebasedmedicine.org/vision-therapy-quackery/}}</ref>

Vision therapy is a broad concept that encompasses a wide range of treatment types.<ref name=kidding/> These include those aimed at [[convergence insufficiency]] – where it is often termed "[[vergence]] therapy" or "orthoptic therapy" – and at a variety of neurological, educational and spatial difficulties.<ref name=kidding>{{cite journal |vauthors=Whitecross S |title=Vision therapy: are you kidding me? Problems with current studies |journal=Am Orthopt J |volume=63 |pages=36–40 |date=2013 |pmid=24260807 |doi=10.3368/aoj.63.1.36 |s2cid=9835985 |type=Review }}</ref>

==Efficacy==
There is no good evidence that vision therapy of any benefit in treating learning disabilities, reading, dyslexia, or ADHD, although there is some evidence that it may help treat [[convergence insufficiency]] in healthy people.<ref name=rucker>{{cite journal |vauthors=Rucker JC, Phillips PH |title=Efferent Vision Therapy |journal=J Neuroophthalmol |volume=38 |issue=2 |pages=230–236 |date=June 2018 |pmid=28059865 |doi=10.1097/WNO.0000000000000480 |s2cid=11582050 |url=}}</ref><ref name="Rawstron">{{cite journal |pmid=15825744 |year=2005 |last1=Rawstron |first1=J. A |title=A systematic review of the applicability and efficacy of eye exercises |journal=Journal of Pediatric Ophthalmology and Strabismus |volume=42 |issue=2 |pages=82–8 |last2=Burley |first2=C. D |last3=Elder |first3=M. J |doi=10.3928/01913913-20050301-02 }}</ref><ref name="Helveston"/> {{asof|2020}} the consensus among ''ophthalmologists'', ''orthoptists'' and ''pediatricians'' is that non-[[Strabismus|strabismic]] visual therapy lacks documented evidence of effectiveness.<ref name=aapos2020>{{cite web |publisher=AAPOS is the American Association for Pediatric Ophthalmology and Strabismus |vauthors=Scott C |date=17 December 2020 |title=Vision Therapy |url=https://aapos.org/glossary/vision-therapy}}</ref>

A review in 2000 concluded that there were insufficient controlled studies of the approach.<ref name=Jennings/> A 2008 review of the literature also noted that there were insufficient controlled studies, and concluded that the approaches "are not evidence-based, and thus cannot be advocated."<ref name=Barrett>{{cite journal |doi=10.1111/j.1475-1313.2008.00607.x |pmid=19154276 |title=A critical evaluation of the evidence supporting the practice of behavioural vision therapy |journal=Ophthalmic and Physiological Optics |volume=29 |issue=1 |pages=4–25 |year=2009 |last1=Barrett |first1=Brendan T |doi-access=free }}</ref>

There is no good evidence supporting the use of vision therapy in the rehabilitation of patients with [[mild traumatic brain injury]], although it may be useful for the treatment of post-traumatic [[convergence insufficiency]] and [[accommodative insufficiency]].<ref>{{cite journal |vauthors=Barton J, Ranalli P |title= Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury |journal=Annals of Neurology |volume=88 |issue=3 |pages=453–461 |date=June 2020 |doi=10.1002/ana.25820|pmid=32542907|s2cid= 219706486 |url=https://doi.org/10.1002/ana.25820|url-access=subscription }}</ref>

==Treatment types==

There exist a few different broad classifications of vision treatment philosophies, which have been traditionally divided between [[optometrist]]s, [[ophthalmologist]]s, and practitioners of alternative medicine.

Orthoptic vision therapy, also known as [[orthoptics]], is a field pertaining to the evaluation and treatment of patients with disorders of the visual system with an emphasis on binocular vision and eye movements.<ref>{{cite web | url=http://www.nhscareers.nhs.uk/explore-by-career/allied-health-professions/careers-in-the-allied-health-professions/orthoptist/ | title=Orthoptist | access-date=8 May 2014}}</ref> Commonly practiced by [[orthoptists]], optometrists, behavioral optometrists, [[Pediatric ophthalmology|pediatric ophthalmologists]], and general ophthalmologists, traditional orthoptics addresses problems of [[asthenopia|eye strain]], visually induced [[headaches]], [[strabismus]], [[diplopia]] and visual-related skills required for [[reading (process)|reading]].

Behavioral vision therapy, or visual integration vision therapy (also known as [[behavioral optometry]]).<ref name="AOA1">American Academy of Ophthalmology. [http://www.aao.org/education/library/cta/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=1224 Complementary Therapy Assessment: Vision Therapy for Learning Disabilities.] {{webarchive|url=https://web.archive.org/web/20061001031817/http://www.aao.org/education/library/cta/loader.cfm?url=%2Fcommonspot%2Fsecurity%2Fgetfile.cfm&PageID=1224 |date=2006-10-01 }} Retrieved August 2, 2006.</ref>

There have been a number of alternative vision therapy approaches which have not been studied in traditional or [[evidence-based medicine]]. They are commonly provided by unlicensed professionals, although a minority of optometrists also provide them. These methods are commonly under scrutiny by ophthalmological and optometric journals for lack of proven effectiveness.{{citation needed|date=October 2021}}

===Orthoptic vision therapy===
{{main|Orthoptics}}
Orthoptics emphasises the diagnosis and non-surgical management of strabismus (wandering eye), amblyopia (lazy eye), and eye movement disorders.<ref name="IOA">International Orthoptic Association document "professional role"</ref> Evidence to support its use in amblyopia is unclear as of 2011.<ref>{{cite journal |last1=West |first1=S |last2=Williams |first2=C |title=Amblyopia. |journal=BMJ Clinical Evidence |date=30 June 2011 |volume=2011 |pmid=21714945 |pmc=3275294}}</ref>

Much of the practice of orthoptists concerns refraction and muscular eye control.<ref>{{cite web |url=http://www.tcos.ca/about_orthoptics.html |url-status=dead |archive-url=https://web.archive.org/web/20040501142128/http://www.tcos.ca/about_orthoptics.html |archive-date=2004-05-01 |title=TCOS.ca :: The Canadian Orthoptic Society}}</ref> Orthoptists are trained professionals who specialize in orthoptic treatment. With specific training, in some countries orthoptists may be involved in monitoring some forms of eye disease, such as glaucoma, cataract screening, and diabetic retinopathy.<ref name="Vukicevic">Vukicevic, M., Koklanis, K and Giribaldi, M. ''Orthoptics: Evolving to meet the increasing demand for eye service''. In Insight news. March 2013: Sydney, Australia.</ref>

=== Behavioral vision therapy ===
Behavioral vision therapy (BVT) aims to treat problems including difficulties of visual attention and concentration,<ref>{{cite news | url=https://www.nytimes.com/2010/03/14/magazine/14vision-t.html | title=Concocting a Cure for Kids With Issues | work=NY Times | date=March 10, 2010 | access-date=9 May 2014 | author=JUDITH WARNER}}</ref> which behavioral optometrists classify as visual information processing weaknesses. These manifest themselves as an inability to sustain focus or to shift focus from one area of space to another.<ref>{{cite web | url=http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf | title=The Stages of Change | publisher=Virginia Polytechnic Institute and State University | access-date=8 May 2014}}</ref> Some practitioners assert that poor eye tracking may impact reading skills, and suggest that vision training may improve some of the visual skills helpful for reading.<ref>{{cite web | url=https://www.wpi.edu/Pubs/E-project/Available/E-project-100112-072059/unrestricted/Eyetracking_and_prompts_for_improved_learning_final.pdf | title=Eye Tracking And Prompts For Improved Learning | publisher=Worcester Polytechnic Institute | access-date=8 May 2014}}</ref>

Behavioral vision therapy is practiced primarily by optometrists who specialize in the area. Historically, there has been some difference in philosophy among optometry and medicine regarding the efficacy and relevance of vision therapy, although none support its use in treating learning disorders. Major organizations, including the [[International Orthoptic Association]] and the [[American Academy of Ophthalmology]], have concluded that there is no validity for clinically significant improvements in vision with BVT, and therefore do not practice it.<ref name=Barrett/> However, major optometric organizations, including the [[American Optometric Association]], the [[American Academy of Optometry]], the [[College of Optometrists in Vision Development]], and the [[Optometric Extension Program]], support the assertion that non-strabismic visual therapy does address underlying visual problems which are claimed to affect learning potential. These optometric organizations are careful to distinguish, though, that vision therapy does not directly treat learning disorders.<ref>{{cite journal | title = Vision, learning and dyslexia. A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association | url = http://www.aoa.org/x1910.xml | journal = Journal of the American Optometric Association | volume = 68 | issue = 5 | pages = 284–6 | year = 1997 | pmid = 9170793 }}</ref>

==== Behavioral optometry ====
Behavioral optometry is a scientifically unproven branch of optometry that explores how visual function influences a patient's day-to-day activities. Vision therapy is a subset of behavioral optometry. In general, vision therapists attempt to improve the vision, and therefore day-to-day [[well-being]], of patients using "eye exercises," prism, and lenses, with more emphasis on the patient's visual function.

Among schools of medicine, ophthalmology does not see merit in the procedures surrounding many of behavioral optometry's practices, as there have not been enough studies of high enough rigor to warrant practicing vision therapy. According to the [[American Association for Pediatric Ophthalmology and Strabismus]], the behavioral aspects of vision therapy are considered scientifically unproven.<ref name=aapos2020/>

===== Techniques =====
In 2008, vision scientist Brendan Barrett published a review of behavioral optometry at the invitation of the UK [[College of Optometrists]]. He wrote that behavioral optometry was not a well-defined field but that proponents believed it could go beyond standard programmes, like an extension to optometry, taking a [[holistic]] approach. Barrett enumerated the therapies:<ref name="Barrett"/>
* Vision therapy for accommodation/vergence disorders&nbsp;– eye exercises and training to try and alleviate these disorders. There is evidence that convergence disorders may be helped by eye exercises, but no good evidence exists that exercises help with accommodation disorders.<!-- ref Barret, above -->
* The underachieving child&nbsp;– therapies claimed to help children with [[dyslexia]], [[dyspraxia]] and [[attention deficit disorder]] – a "vulnerable" target market. There is no evidence that behavioral optometry is of any benefit in relation to these conditions.<!-- ref above -->
* Prisms for near binocular disorders and for producing postural change&nbsp;– the use of "yoked" prisms to redirect a person's gaze and bring about a range of claimed benefits including postural improvements and increased wellbeing. There is a lack of evidence for the effect this approach may have.<!-- ref above -->
* Near point stress and low-plus&nbsp;– the use of special lenses to adjust near-field vision, even for people who would not normally need glasses. This is claimed to bring about postural benefits and relieve visual stress. Some research has been carried out in this area and its effectiveness remains "unproven".<!-- ref above -->
* Use of low-plus lenses at near to slow the progression of myopia.<!-- ref above -->
* Therapy to reduce myopia.<!-- ref above -->
* Behavioural approaches to the treatment of strabismus and amblyopia.<!-- ref above -->
* Training central and peripheral awareness and syntonic.<!-- ref above -->
* Sports vision therapy.<!-- ref above -->
* Neurological disorders and neurorehabilitation after trauma/stroke.<!-- ref above -->

Barrett noted the lack of published controlled trials of the techniques. He found that there are a few areas where the available evidence suggest that the approach might have some value, namely in the treatment of convergence insufficiency, the use of yoked prisms in neurological patients, and in vision rehabilitation after brain disease or injury—but he found that in the other areas where the techniques have been used, i.e., the majority of situations, there is no evidence of their value.<ref name=Barrett/> In contrast, [[Steven Novella]] points out that the only condition for which there is good quality scientific evidence is convergence disorders. This points out a problem that is common with Complementary or integrative medicine, a type of [[Alternative medicine]], is that a promising use for treating a single disorder is applied to a wide range of disorders for which there is no evidence.<ref name=novella/>

=====Eye exercises=====
The eye exercises used in vision therapy can generally be divided into two groups: those employed for "strabismic" outcomes and those employed for "non-strabismic" outcomes, to improve eye health.
Ophthalmologists and orthoptists do not endorse these exercises as having clinically significant validity for improvements in vision. Usually, they see these perceptual-motor activities being in the sphere of either [[speech therapy]] or [[occupational therapy]].

Some of the exercises used are:
* Near the point of [[Convergence (eye)|convergence]] training, or the ability for both eyes to focus on a single point in space.
* Base-out prism reading, [[stereoscopy|stereogram]] cards, computerized training programs are used to improve [[fusional vergence]].<ref>{{cite web | url=http://emedicine.medscape.com/article/1199429-treatment | title=Convergence Insufficiency Treatment & Management | website=Medscape | access-date=8 May 2014 | author=Michael J Bartiss}}</ref>
* The wearing of [[convex lenses]].<ref>{{cite web | url=http://www.ophth.wisc.edu/news/kushner_book/Eye%20Muscle%20Problems%20In%20Children%20and%20Adults.pdf | title=Eye Muscle Problems in Children and Adults: A Guide to Understanding | author=Burton J. Kushner | year=2014}}</ref>
* The wearing of [[Biconcave lens|concave lenses]].
* "Cawthorne Cooksey Exercises" also employ various eye exercises, however, these are designed to alleviate vestibular disorders, such as dizziness, rather than eye problems.<ref name="dizziness-and-balance1">{{cite web|url=http://www.dizziness-and-balance.com/treatment/rehab/cawthorne.html |title=Cawthorne-Cooksey Exercises for Dizziness |publisher=Dizziness-and-balance.com |access-date=2013-02-15}}</ref>
* Antisuppression exercises for [[amblyopia]] - this is no longer commonly practiced, although occasionally it may be used.

Eye exercises used in behavioural vision therapy, also known as developmental optometry, aim to treat problems, including difficulties of visual attention and concentration, which may manifest themselves as an inability to sustain focus or to shift focus from one area of space to another.{{citation needed|date=March 2021}}

Some of the exercises use:{{citation needed|date=March 2021}}
* Marsden balls
* Rotation trainers
* Syntonics
* Balance board or beams
* Saccadic fixators
* Directional sequencers

Fusional amplitude and relative fusional amplitude training are designed to alleviate [[convergence insufficiency]]. The CITT study (Convergence Insufficiency Treatment Trial) was a randomized, double-blind multi-center trial (high level of reliability) indicating that orthoptic vision therapy is an effective method of treatment of convergence insufficiency (CI). Both optometrists and ophthalmologists were coauthors of this study.{{citation needed|date=March 2021}} Fusional amplitude training is also designed to alleviate intermittent [[exotropia]]<ref name="Zhang KK 2007">{{cite journal | author1 = Zhang KK |author2=Koklanis K |author3=Georgievski Z | year = 2007 | title = Intermittent exotropia: A review of the natural history and non-surgical treatment outcomes | journal = Australian Orthoptic Journal | volume = 39 | issue = 1| pages = 31–37 }}</ref> and other less common forms of strabismus.

Certain [[do-it-yourself]] eye exercises are claimed by some to improve [[visual acuity]] by reducing or eliminating [[refractive errors]]. Such claims rely mainly on [[anecdotal evidence]], and are not generally endorsed by orthoptists, ophthalmologists or optometrists.<ref name=Quackwatch>{{cite web | url=http://www.quackwatch.com/01QuackeryRelatedTopics/eyequack.html | title=Eye-Related Quackery |date = 6 July 2018 | publisher=Quackwatch | first=Russell |last=Worrall|author2=Nevyas, Jacob |author3=Barrett, Stephen }}</ref><ref name=AllAboutVision>{{cite web |url = https://www.allaboutvision.com/buysmart/see_clearly.htm |title = Do eye exercises improve vision? |date = March 2021 |publisher = AllAboutVision.com |first = Gary |last = Heiting |access-date = 20 March 2021 }}</ref>

The German optician [[Hans-Joachim Haase (optician)|Hans-Joachim Haase]] developed a method to correct an alleged misalignment. His method, called the ''[[MKH method]]'', is not recognized as an evidence-based approach.<ref>{{cite journal |doi=10.1055/s-2002-32883 |title=Bessern Prismen nach Hans-Joachim Haase die Stereosehschärfe? |trans-title=Do prisms according to Hans-Joachim Haase improve stereoacuity? |language=de |journal=Klinische Monatsblätter für Augenheilkunde |volume=219 |issue=6 |pages=422–8 |year=2002 |last1=Kromeier |first1=Miriam |last2=Schmitt |first2=Christina |last3=Bach |first3=Michael |last4=Kommerell |first4=Guntram |pmid=12136437|s2cid=72028637 }}</ref><ref>{{cite journal |doi=10.1055/s-2006-927268 |title=Beeinflussen Prismen nach H.-J. Haase die Augenprävalenz? |trans-title=Do Prism Corrections According to H.-J. Haase Affect Ocular prevalence? |language=de |journal=Klinische Monatsblätter für Augenheilkunde |volume=224 |issue=1 |pages=32–9 |year=2007 |last1=Schroth |first1=V |last2=Jaschinski |first2=W |url=https://zenodo.org/record/889796 |pmid=17260317|s2cid=260203639 }}</ref><ref>{{cite journal |pmid=11840793 |year=2002 |last1=Kommerell |first1=G |title=Prism correction in heterophoria |journal=Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft |volume=99 |issue=1 |pages=3–9 |last2=Kromeier |first2=M |doi=10.1007/PL00007112 |s2cid=9739355 }}</ref><ref>{{cite journal |doi=10.1007/bf03163758 |title=Wie notwendig sind Prismen? Verzicht auf Polatest-induziert fehlapplizierte Prismenbrillen in mehr als 70 Fällen |trans-title=How necessary are prisms? In more than 70 cases taking away prism which have been wrongly applied based on pola test-procedure only |language=de |journal=Spektrum der Augenheilkunde |volume=9 |issue=2 |pages=63–73 |year=1995 |last1=Brügger |first1=N |last2=Champion |first2=R |last3=Flury-Cornelis |first3=H |last4=Payer |first4=G |last5=Payer |first5=H |last6=Siegenthaler |first6=B |last7=Starkermann |first7=M |last8=Weisstanner |first8=B |s2cid=24248991 }}</ref>
[[File:186NanjingEyeExercises.jpg|thumb|A class at Nanjing No. 1 Experimental School performs eye exercises (2007).]]
Beginning in the early 1960s, the Chinese government, concerned about the high incidence of nearsightedness among the Chinese population, undertook a programme to combat this problem. In 1963, the government began requiring schoolchildren between the ages of 6 and 17 to perform eye exercises at school. Ever since, this has been a common practice at schools in the People's Republic. The actual method used by the schoolchildren to exercise their eyes is based on traditional Chinese massage therapy, involving self-massage of acupoints around the eyes. The programme's effectiveness, however, is very much in question, given that over the same time as that in which there have been regular school eye exercises, the prevalence of nearsightedness among Chinese children, quite contrarily to the government's intended goal, has risen significantly.<ref>{{cite web
|last1       = Tang
|first1      = Jie
|last2       = Pei
|first2      = Yifei
|date        = 10 March 2023 
|title       = The association between Chinese eye exercises and myopia in children and adolescents: A systematic review and meta-analysis
|url         = https://pmc.ncbi.nlm.nih.gov/articles/PMC10036375/
|website     = pmc.ncbi.nlm.nih.gov
|location    = 
|publisher   = Frontiers in Public Health
|access-date = 7 January 2025
}}</ref>

===== Conceptual basis and effectiveness =====
Behavioral optometry is largely based on concepts that lack plausibility or which contradict mainstream [[neurology]], and most of the research done has been of poor quality.<ref name=sbm>{{cite web |website=Science-Based Medicine |title=A Science Lesson from a Homeopath and Behavioral Optometrist |access-date=1 March 2015 |author=Novella, Steven |author-link=Steven Novella |url=http://www.sciencebasedmedicine.org/a-science-lesson-from-a-homeopath-and-behavioral-optometrist/ |date=28 October 2009}}</ref> As with [[chiropractic]], there seems to be a spectrum of scientific legitimacy among practitioners: at one extreme there is some weak evidence in support of the idea that myopia may be affected by eye training;<ref name=Barrett/> at the other extreme are concepts such as "syntonic phototherapy" which proposes that differently colored lights can be used to treat a variety of medical conditions.<ref name=sbm/>

A review in 2000 concluded that there were insufficient controlled studies of the approach.<ref name=Jennings>{{cite journal | author=Jennings | year=2000 | title=Behavioural optometry – a critical review | journal=[[Optometry in Practice|Optom. Pract.]] | volume=1 | issue=67}}</ref> In 2008 Barrett concluded that "the continued absence of rigorous scientific evidence to support behavioural management approaches, and the paucity of controlled trials, in particular, represents a major challenge to the credibility of the theory and practice of behavioural optometry."<ref name=Barrett/>

Behavioral optometry has been proposed as being of benefit for children with [[attention deficit hyperactivity disorder]] and [[autism]] – this proposal is based on the idea that since people with these conditions often have abnormal eye movement, correcting this may address the underlying condition. Evidence supporting this approach is, however, weak; the [[American Academy of Pediatrics]], the [[American Academy of Ophthalmology]] and the [[American Association for Pediatric Ophthalmology and Strabismus]] have said that learning disabilities are neither caused nor treatable by visual methods.<ref>Wolraich ''et al''. 2008, [https://books.google.com/books?id=4zNkiMA_SggC&pg=PA269 pp. 269-270].</ref>

===Sports vision training===
Practitioners of sports vision training claim to be able to enhance the function of an athlete's vision beyond what is expected in individuals with already healthy visual systems.<ref>[https://www.aoa.org/optometrists/membership/aoa-sections/sports-vision-section "Sports & Performance Vision: Tools for expanding your practice and reaching new patients."] [[American Optometric Association]]. Retrieved April 11, 2020.</ref><ref>Erickson, Graham (2007). ''[https://www.elsevier.com/books/sports-vision/9780750675772 Sports Vision]''. Butterworth-Heinneman. {{ISBN|9780750675772}}</ref>{{bsn|date=October 2021|reason=This needs more context}}

== History ==
Various forms of eye exercises have been used for centuries.<ref name="Helveston">{{cite journal|last1=Helveston|first1=Eugene M|year=2005|title=Visual Training: Current Status in Ophthalmology|journal=American Journal of Ophthalmology|volume=140|issue=5|pages=903–10|doi=10.1016/j.ajo.2005.06.003|pmid=16310470}}</ref> The concept of orthoptics was introduced in the late nineteenth century for the non-surgical treatment of [[strabismus]]. This early and traditional form of vision therapy was the foundation of what is now known as [[orthoptics]] and was based on observation not research or evidence.<ref>{{cite journal|last1=Georgievski|first1=Zoran|last2=Koklanis|first2=Konstandina|last3=Fenton|first3=Adam|last4=Koukouras|first4=Ignatios|year=2007|title=Victorian orthoptists' performance in the photo evaluation of diabetic retinopathy|journal=Clinical & Experimental Ophthalmology|volume=35|issue=8|pages=733–8|doi=10.1111/j.1442-9071.2007.01576.x|pmid=17997777|s2cid=8661627}}</ref>

In the first half of the twentieth century, orthoptists, working with [[ophthalmologists]], introduced a variety of training techniques mainly designed to improve ocular alignment. In the second half of the twentieth century, vision therapy began to be used by specially trained optometrists to treat conditions ranging from uncomfortable vision (asthenopia), ocular motor skills, focusing control, binocular vision, depth perception, eye-hand coordination and visual processing. These treatments have been demonstrated to help many patients with poor reading and academic performance caused by their vision. There are many unscientific techniques promoted commercially and claimed specifically to improve eyesight and even to improve athletic performance.<ref name="Helveston" />

=== Behavioral optometry ===
Behavioral optometry is considered by some optometrists to have its origins in the teachings of Skeffington and Alexander. They promoted continuing education for optometrists to further their knowledge of how vision impacts performance. Vision therapy is differentiated between strabismic/orthoptic vision therapy (which many optometrists, [[orthoptist]]s and [[ophthalmologist]]s practice) and non-strabismic vision therapy.<ref>{{cite journal |pmid=8014367 |year=1994 |last1=Birnbaum |first1=M. H |title=Behavioral optometry: A historical perspective |journal=Journal of the American Optometric Association |volume=65 |issue=4 |pages=255–64 }}</ref> [[A.M. Skeffington]] was an American [[optometrist]] known to some as "the father of behavioral optometry".<ref name="Visionaries">[http://legacy.revoptom.com/archive/resource/visionaries.htm#skeffington "A.M. Skeffington, O.D.: The Father of Behavioral Optometry."] Visionaries
(Reprinted from January–December 1991 Issues of Review of Optometry)
Review of Optometry. Accessed February 5, 2012.</ref> Skeffington has been credited as co-founding the [[Optometric Extension Program]] with E.B. Alexander in 1928.<ref name="Visionaries"/>

==See also==
* [[Bates method]]
* [[Irlen syndrome]]
* ''[[Journal of Behavioral Optometry]]''
* [[Reichian therapy]]
* [[Visual Snow]]

==References==
{{reflist}}

== Further reading ==
* {{Cite journal |vauthors=Handler SM, Fierson WM |date=March 2011  |title=Learning Disabilities, Dyslexia, and Vision |journal=Pediatrics |type=Review |volume=127 |issue=3 |pages=e818–56 |pmid=21357342 |doi=10.1542/peds.2010-3670 |doi-access=free }}
* {{Cite web |vauthors=Worrall RS, Nevyas J, Barrett S |date=6 July 2018 |title=Eye-Related Quackery |url=http://www.quackwatch.com/01QuackeryRelatedTopics/eyequack.html |publisher=[[Quackwatch]] |access-date=20 March 2021}}

{{DEFAULTSORT:Vision Therapy}}
[[Category:Alternative medical treatments]]
[[Category:Eye procedures]]
[[Category:Optometry]]
[[Category:Pseudoscience]]
[[Category:Therapy]]
[[Category:Vision]]